CRITERIA_REVIEW
Description:
This table contains information about medical necessity criteria reviews. The records included in this table are Criteria Review Records (CRR) records storing items that a case manager would enter in the Utilization Review activity or during a criteria review completed in Tapestry. For example, this includes the review outcome, guideline days, and the time and date the review was completed.

Primary Key
Column Name Ordinal Position
CRITERIA_REVIEW_ID 1

Column Information
Name Type Discontinued?
1 CRITERIA_REVIEW_ID NUMERIC No
The unique ID of the criteria review record.
2 CRITERIA_REV_NAME VARCHAR No
The name of the criteria review record.
3 PATIENT_ID VARCHAR No
Stores the patient the criteria review is for.
4 OBJECT_TYPE_C_NAME VARCHAR No
The type of record the criteria review is for.
May contain organization-specific values: No
Category Entries:
RFL
5 REFERRAL_ID NUMERIC No
The ID of the referral that is associated with the criteria review.
6 REVIEW_ID VARCHAR No
The review ID associated with the criteria review.
7 REVIEW_NUMBER VARCHAR No
The review number of the criteria review record.
8 CRITERIA_SET_NAME VARCHAR No
The criteria set name for this criteria record.
9 CRITERIA_STATUS_C_NAME VARCHAR No
The status of the criteria review.
May contain organization-specific values: No
Category Entries:
Not Met
Met
In Progress
Completed
Acute Met
Critical Met
Observation Met
Alternate Met
Intermediate Met
Not Applicable
Neonatal Intensive Care Level III Met
Special Care Level II Met
Newborn Level I Met
Transitional Care Met
Neonatal Intensive Care Level IV Met
Variance
Partially Met
Ambulatory Detoxification Met
Home Care Met
Inpatient Met
Inpatient Detoxification Met
Intensive Community-Based Treatment Met
Intensive Outpatient Program Met
Outpatient Met
Partial Hospital Program Met
Subacute Care Met
Residential Crisis Program Met
Residential Treatment Center Met
Supervised Living Met
Inpatient Rehabilitation Met
Not Met (Not Selected)
Not Met (Selected)
Met (Not Selected)
Met (Selected)
Level I Met
Level II Met
Level III Met
Subacute Met
Hospital in the Home Met
Day Treatment Program Met
Neutral
Skilled Nursing Facility Met
Behavioral Health Observation Met
SNF Met
Supplemental Medicare Criteria Met
10 SERVICE_DATE DATETIME No
The service date associated with this criteria review record.
11 PROVIDER_ID VARCHAR No
The unique ID of the provider associated with the criteria review.
12 PROVIDER_ID_REFERRING_PROV_NAM VARCHAR No
The name of the referral source.
13 NOTE_ID VARCHAR No
The unique ID of any notes associated with this criteria review.
14 REVIEW_STATUS_C_NAME VARCHAR No
Review status for criteria using CERMe (third-party software from McKesson used for utilization review).
May contain organization-specific values: No
Category Entries:
Pending Primary
In Primary
Pending Secondary
Pending Secondary-Medical
Pending Appeal
Completed
In Progress
Waiting For Info
Primary Completed
Secondary Completed
Deleted
15 PATIENT_CSN NUMERIC No
Stores the Patient Contact Serial Number for the encounter in which the review was created.
16 REV_TYPE_C_NAME VARCHAR No
Stores the type of review that is performed - Admission, Concurrent, Discharge, etc.
May contain organization-specific values: Yes
Category Entries:
Admission
Continued Stay
Discharge
Preadmission
Outpatient Procedure
Unspecified
Planned Admission
Emergent Admission
Initial Review
17 ADDITIONAL_NOTES_ID VARCHAR No
Stores additional comments or notes related to the review.
18 REVIEW_INSTANT_DTTM DATETIME (UTC) No
Stores the instant the review was filed.
19 CONTENT_SOURCE_C_NAME VARCHAR No
The content provider used for this review.
May contain organization-specific values: Yes
Category Entries:
InterQual©
MCG©
20 REVIEW_DX_ID_DX_NAME VARCHAR No
The name of the diagnosis.
21 REVIEW_PX_ID_PROC_NAME VARCHAR No
The name of each procedure.
22 CRITERIA_OUTCOME_C_NAME VARCHAR No
Final determination of the review.
May contain organization-specific values: Yes
Category Entries:
Approved
Referred for medical review
Waiting for more information
Request withdrawn
Review interrupted
Alternate procedure/referral/LOC selected
Certified
Directed to New Criteria Subset
Discharged with no further treatment
Non-Certified
Not Appropriate
Not Approved
Overturned
Partially Certified
Redirected
Refer to Case Management
Referred for Peer Review
Refer for Secondary
Request Canceled
Appropriate
Clinically stable for discharge
Other
23 PARENT_REVIEW_ID NUMERIC No
Points to the parent criteria review that generated this review.
24 REV_DAY_TYPE_C_NAME VARCHAR No
Stores the type of day for this review.
May contain organization-specific values: Yes
Category Entries:
Clinical Indication
Care Day
Extended Stay
Operative Status
Intensive Care
Intermediate Care
Telemetry Care
25 REVIEW_DAY INTEGER No
Stores the numeric day of the review.
26 GUIDELINE_DAY INTEGER No
Stores the current Guideline Day for an MCG Optimal Recovery Course.
27 COMP_INST_UTC_DTTM DATETIME (UTC) No
The time and date a utilization review was marked complete.
28 COMP_USER_ID VARCHAR No
The user who marked a utilization review as complete.
29 COMP_USER_ID_NAME VARCHAR No
The name of the user record. This name may be hidden.
30 REVIEW_SELECTED_YN VARCHAR No
This row indicates whether a patient status associated with a review is the status selected by the user. Selection is relevant for reviews in which the user can check off criteria for more than one patient status such as observation or inpatient, but for which the user must select one target patient status to file the review. If the patient status associated with the review is the selected status, this item is set to Yes. If the patient status associated with a review is not the status selected by the user, it is set to No. If this item is empty, then the review does not have an associated patient status that is either selected or not selected.
May contain organization-specific values: No
Category Entries:
No
Yes
31 CREATION_REVIEWER_USER_ID VARCHAR No
The reviewer who first created this review.
32 CREATION_REVIEWER_USER_ID_NAME VARCHAR No
The name of the user record. This name may be hidden.
33 CREATION_INST_UTC_DTTM DATETIME (UTC) No
The instant at which this review was created.
34 OVERALL_DETERMINATION VARCHAR No
Textual representation of the overall determination of a review.
35 REVIEW_VENDOR_C_NAME VARCHAR No
This item stores which criteria review vendor created the review.
May contain organization-specific values: Yes
36 AUTH_REQUEST_STATUS VARCHAR No
Authorization request status from a third party criteria review vendor.
37 AUTH_REQUEST_ID NUMERIC No
The authorization request associated with the guideline review.